Knowledge, Attitudes, and Predictors of Advance Directive Discussions of Registered Nurses

Abstract

The purpose of this study was to describe nurses' knowledge, attitudes, and experiences regarding advance directives. A secondary purpose was to examine predictors of advance directive discussions between nurses and patients. Seven-hundred and nineteen respondents, randomly selected from a list of registered nurses in the state of Ohio, completed mailed questionnaires. Descriptive t test, chi-square, and logistic regression statistics were used in the data analyses. The respondents were knowledgeable and possessed positive attitudes about advance directives. Higher self-perceived confidence in advance directive discussion skills and the experience of caring for at least one patient with a current advance directive were found to be significant predictors of advance directive discussions. These findings suggest that experience with advance directives documents is critical for nurses' comfort and that developing interventions to further nurses' confidence in their discussion skills may increase advance directive discussions.

Knowledge, Attitudes, and Practice Behaviors of Oncology Advanced Practice Nurses Regarding Advanced Care Planning for Patients With Cancer

“…The factor analysis showed a modestly high correlation (r = 0.67) between factor 1 and factor 2, suggesting that factor 2 may be a stronger predictor for advanced care planning practice. This finding supported results from previous studies on physicians and RNs, indicating that attitudes (particularly comfort levels) were positively associated with hospice referrals and advance directives discussions (Bradley et al, 2002, Cramer et al, 2003Lipson et al, 2004). Additionally, oncology APN respondents in the current survey reported that their advanced care planning practices were only somewhat routine, which was comparable to the 39% of general NPs who regularly initiated advanced care planning surveyed by Schlegel and Shannon (2000).…”

“…Oncology APN respondents in the current study also demonstrated fairly positive attitudes toward advanced care planning. They felt comfortable discussing advanced care planning and related issues with patients and families, similar to the results found among general NPs and RNs (Badzek et al, 2006;Cramer et al, 2003;Lipson et al, 2004;Schlegel & Shannon, 2000;Tyree, Long, & Greenberg, 2005). On the other hand, physicians appeared to be less comfortable discussing endof-life care issues with patients and families (Bradley et al, 2002).…”

“…Among RNs, knowledge about end-of-life care and advance directives varied. Lipson et al (2004) studied 719 RNs from Ohio and found that they were generally knowledgeable and possessed positive attitudes toward advance directives.…”

“…Many clinicians had biased views about advance directives, and some perceived that patients and family members were reluctant to discuss these care issues. In addition, insufficient knowledge exists among clinicians regarding advance directives and end-of-life or hospice care, and most felt inadequately trained to deliver news, such as a cancer diagnosis or prognosis and recommending end-of-life care options (Badzek et al, 2006;Bradley et al, 2002;Cramer, McCorkle, Cherlin, JohnsonHurzeler, & Bradley, 2003;Duke & Thompson, 2007;Feeg & Elebiary, 2005;Jezewski, Brown, et al, 2005;Jezewski, Meeker, & Robillard, 2005;Lipson, Hausman, Higgins, & Burant, 2004;Morrison, Morrison, & Glickman, 1994;Scherer, Jezewski, Graves, Wu, & Bu, 2006).…”

Perceptions of North Dakota registered nurses regarding advance directives

“…In contrast, a Canadian study by Molloy et al (1997) found that 97% of the 29 visiting nurses participating in a program to educate patients about advance directives and assist them with completion agreed with the statement that patients need to be more involved in their own health care decisions and that they have a right to refuse or accept medical treatment. A larger and more recent study of Ohio nurses knowledge, attitudes, and predictors of advance directive discussions (Lipson, Hausman, Higgins, & Burant, 2004) found that respondents (n=719) had moderately positive attitudes toward advance directives (M=3.45; SD=1.12; range of I to 5 with 5=strongly agree, 4=agree, 3=undecided, 2=disagree, and 1 =strongly disagree), with age positively correlated with this positive attitude (r=.89; p=.02) while years of nursing experience was not. Respondents disagreed that advance directives represent an unwarranted extension of the law into medicine and that prolonging life is more important than honoring a patient's request to forego life-sustaining treatment (M= 1.4 1).…”